title: Impact on clinical outcomes of predilatation using the kissing-balloon technique for crossover stenting in true coronary bifurcation lesions.
abstract: BACKGROUND
  Provisional crossover stenting has the potential risk of side-branch (SB) compromise, which may result in periprocedural myocardial infarction. Predilatation is a useful technique to prevent SB compromise.
  
  
  OBJECTIVE
  The aim of this study was to assess the safety and efficacy of predilatation using the kissing-balloon technique (preKBT) during provisional crossover stenting compared with sequential predilatation on clinical outcomes in true coronary bifurcation lesions.
  
  
  METHODS
  We retrospectively evaluated 204 consecutive non-left main true bifurcation lesions (182 patients) in whom provisional crossover stenting was performed with preKBT (preKBT group, n = 144) or sequential predilatation (sequential group, n = 60) from March 2006 to February 2012.
  
  
  RESULTS
  There were 30 lesions (20.8%) in the preKBT group that developed SB ostial dissection compared with 8 lesions (13.3%) in the sequential group (P=.241). There was no SB flow impairment or SB access failure due to SB ostial dissection. SB compromise (Thrombolysis in Myocardial Infarction <3) immediately after crossover stenting occurred in 5 lesions (3.5%) in the preKBT group versus 7 lesions (11.7%) in the sequential group (P=.043). Major adverse cardiac events at 6-8 months of follow-up were observed in 5 lesions (3.5%) in the preKBT group versus 8 lesions (13.3%) in the sequential group (P=.022).
  
  
  CONCLUSIONS
  Regardless of more complex bifurcation lesions in the preKBT group, preKBT successfully prevented SB compromise due to crossover stenting without unfavorable complications and improved the mid-term clinical outcome compared with sequential PTCA in patients with non-left main, true coronary bifurcation lesions.
authors.affiliation: Division of Cardiology, Kusatsu Heart Center, 407-1, Komaizawa-cho, Kusatsu, Shiga, 525-0014 Japan. ohya@kusatsu-heartcenter.co.jp.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Ohya
authors.forename: Eisho
authors.initials: E
authors.lastname: Kyo
authors.forename: Takafumi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome